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Comparison of acute physiology and chronic health evaluation II death risk, Child-Pugh, Charlson, and model for end-stage liver disease indexes to predict early mortality after liver transplantation.

Research paper by A A Basile-Filho, E A EA Nicolini, M M Auxiliadora-Martins, G C GC Alkmim-Teixeira, E Z EZ Martinez, O A OA Martins-Filho, O O de Castro e Silva

Indexed on: 23 Jun '11Published on: 23 Jun '11Published in: Transplantation Proceedings



Abstract

This study sought to determine which prognostic index was the most efficient to predict early (1-month) mortality of patients undergoing orthotopic liver transplantation (OLT).This retrospective study included 63 patients including 49 males and 14 females of overall median age 51.6 ± 9.7 years who were admitted to the intensive care unit (ICU) of a tertiary hospital. The Acute Physiology and Chronic Health Evaluation II (APACHE II) death risk, Child-Pugh, Charlson, and Model for End-stage Liver Disease (MELD) indices pre-OLT and post-OLT were analyzed by generation of receiver operating characteristic (ROC) curves to determine the area under the ROC curve (AUC), as a predictive factor for each index. The level of significance was set at P < .05.The general 1-month posttransplantation mortality rate of OLT patients was 19% (n = 12 p). The AUC was 0.81 (confidence interval [CI] = 0.66-0.96; sensitivity = 72.5; specificity = 83.3) for APACHE II death risk; 0.74 (CI = 0.57-0.92; sensitivity = 76.5; specificity = 66.7) for MELD post-OLT; 0.70 (CI = 0.54-0.85; sensitivity = 64.7; specificity = 66.7) for Child-Pugh; 0.57 (CI = 0.36-0.78; sensitivity = 74.5; specificity = 50.0) for Charlson; and 0.50 (CI = 0.32-0.69; sensitivity = 98.0; specificity = 16.7) for MELD Pre-OLT.Among the studied indices, the APACHE II death risk scoring system was the most effective to predict early mortality after OLT.